Miamidades Plan To Require A Share Of Ambulance Fees May Violate Law

By Paola Iuspa Miami-Dade County might violate Medicare and Medicaid laws if it proceeds with plans to have a private ambulance firm pay a fee in exchange for an exclusive contract.

American Medical Response, 7255 NW 19th St., currently provides the urgent transport service. The company has done business with the county for about a decade but previously was not asked to pay the exclusivity charge, said Miguel De Grandy, the lawyer representing American.

But American’s contract expires in April and the Miami-Dade Consumer Services Department – part of county government – is seeking new bids for an ambulance team to augment regular emergency police- and fire-rescue services.

The current invitation for bids, with responses due Feb. 26, calls for a two-year contract and for the winning company to propose paying the county a percentage of the fees it charges patients for the service. As now proposed by the county, the company that meets the minimum requirements spelled out in the document and offers the county the highest fee per ambulance trip will win the contract, Mr. De Grandy said.

The county only uses the private ambulance operator when all county medical vehicles are tied up transporting other patients or responding to calls. Back-up service providers last year handled more than 4,000 calls, according to county documents.

A state representative from 1989 to 1994, Mr. De Grandy last week questioned the propriety of the exclusivity fee requirement before the Miami-County Commission. He said his client wants to respond to the new bid but would not do so until the document is proven legal.

A 1991 Medicare fraud alert from the Department of Health and Human Services’ Office of Inspector General stated that "any municipality requesting money from an ambulance company to award such a contract and/or any ambulance company providing a fee to the municipality for referrals of patients may be in violation of the Medicare and Medicaid anti-kickback statute." The county’s bid proposal may conflict with the HHS law in cases where the ambulance service was rendered to patients using Medicare or Medicaid to pay.

Miami-Dade Assistant County Attorney Jack Hartog said he is analyzing the allegation. "The bid document is under review," he said Friday.

Sheila Rushton, director of the Consumer Services Department, was not able to comment on the issue because the county code does not allow Miami-Dade officials to talk about a bid before its due date, said Aimee Artiles, a county’s spokeswoman.

A spokesman for the Office of Inspector General with the federal office of Health and Human Services said committing Medicare or Medicaid fraud is not a black-and-white issue. Any ruling on the propriety of a contract, said spokesman Ben St. John, would depend on many factors, including how the bid document was worded.

"Anyone who suspect of a violation should submit that information to the Office of Inspector General," he said. The office has an application process in which the applicant pays a fee to get a written advisory opinion by the office’s legal staff, Mr. St. John said.

In this case, he said, any of the interested parties could write to his office for the legal advisers to determine if an opinion could be issued.

Mr. De Grandy is also raising questions about why the county’s new bid document does not establish a minimum number of licensed ambulances for the operator to control, he said. The county’s next ambulance company could have three ambulances or 20, he said, and it would make no difference in the contract awarding.